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Biomedical subjects

C Cuccia

Publications and source records attributed to C Cuccia.

At least 19 recordsLinked to original sources
PubMed2000

Determination of decision limits for ACS:systems cardiac troponin I.

The availability of specific markers of myocardial damage has focused attention on the decision limits to be used in clinical practice. These markers can be employed in the diagnosis of myocardial infarction and risk stratification in patients with acute coronary syndromes but no infarction. The measurement of troponin I was undertaken in two 60 patient cohorts with these disease classifications. The best decision level for patients with acute myocardial infarction was found to be 3.1 microg/l; for the detection of minimal myocardial damage the cut-off was equal to the detection limit of the method (0.2 microg/l).

Humans↗
PubMed1998

Comparison of the diagnostic performance of two rapid bedside biochemical assays in the early detection of acute myocardial infarction.

BACKGROUND: New biochemical markers have been recently proposed as potential aids in the diagnosis of myocardial infarction. Assessment of these markers in real time by near-patient testing would allow more rapid decisions regarding critical therapeutic interventions. HYPOTHESIS: The diagnostic performance of two qualitative, whole blood assays for measurement of myoglobin/creatine kinase (CK)-MB mass (CARDIAC STATus) and cardiac troponin T (TropT) was compared. Their potential in optimizing the rule-in of patients with infarction in order to initiate revascularization therapies was also evaluated. METHODS: A group of 101 patients admitted to the hospital within 12 h from onset of symptoms suggestive of myocardial infarction was studied. A first blood sample was drawn in all patients immediately after admission. In patients not receiving reperfusion therapy (n = 61), three additional samples were also obtained 2, 4, and 6 h later. RESULTS: CARDIAC STATus showed good performance in patients with an admission time > 2 h from onset of pain (diagnostic efficiency, 71-100%). Conversely, TropT was not sensitive enough for acceptable efficiency. In a subset of 39 patients admitted within 6 h who did not meet standard enrollment criteria for thrombolysis, CARDIAC STATus allowed early detection of almost 50% of infarcts, enabling a significant implementation of alternative revascularization therapies. CONCLUSIONS: In patients admitted to the coronary care unit on the basis of case history and clinical examination, CARDIAC STATus assay is more effective than TropT in the early diagnosis of infarction, providing a valuable aid to cardiologists for confirming a suspected infarction rapidly, thus allowing, if indicated, recourse to revascularization therapy in clinically uncertain cases.

Biomarkers↗
PubMed1998

[A rare case of massive pulmonary embolism and in transit cardiac thrombosis].

The case of a patient affected with acute pulmonary embolism and concomitant cerebral thromboembolism is described. The patient was admitted to our Coronary Care Unit with aphasia and hemiplegia. Five days before, he had undergone a hip replacement. A lung scan showed bilateral embolism; transthoracic echocardiogram revealed signs of pulmonary hypertension and the presence of a large, elongated, highly mobile "in-transit" thrombus entrapped into a patent foramen ovalis, and prolapsing into the right and left ventricle during diastole. The patient underwent surgical removal of the thrombus, with closure of the patent foramen. We did not treat the patient with thrombolysis, fearing the damage that a new embolism might produce. After surgery, the patient had a lengthy hospital stay because of renal failure and infection due to Pseudomonas aeruginosa. The patient was discharged from the hospital three months later on dialytic treatment and although he was still aphasic, there was partial recovery of motor function. Nevertheless, normalization of renal function and regression of aphasia occurred during the following months, with a residual mild motor defect of the right hand. This case report represents a starting point for discussing treatment of "in-transit" thrombi during pulmonary embolism.

Acute Kidney Injury↗
PubMed1990

[Thrombolytic therapy in the treatment of thromboembolism of the right cardiac cavity during pulmonary embolism: our experience with rt-PA and review of the literature].

In 4 consecutive patients admitted for multiple pulmonary embolism 2-dimensional echocardiography showed large right atrial migrant thromboemboli in transit, floating and prolapsing into the right ventricle in diastole. This pattern was always associated with the echocardiographic signs of pulmonary hypertension. All the patients were treated with intravenous infusion of 100 mg of rt-PA in 3 hours. rt-PA determined the dissolution and disappearance of the right atrial thromboemboli (it took 4 hours in 2 patients and 5 hours in the remaining 2), and the concomitant disappearance of the echocardiographic signs of pulmonary hypertension. During and after the rt-PA therapy there was no evidence of further pulmonary embolism. The fibrinolytic treatment for right atrial thromboemboli during multiple pulmonary embolism is a promising alternative to right atrial thrombectomy: our results indicate that rt-PA acts rapidly and is effective and safe; if these results will be confirmed in a larger group of patients, rt-PA could become the first-choice therapy of right atrial thromboembolus.

Aged↗
PubMed1990

[ST segment depression in precordial leads in patients with inferior acute myocardial infarction: the role of right ventricular involvement].

The aim of the present study was to evaluate the influence of right ventricular involvement on the magnitude of precordial ST segment depression during inferior acute myocardial infarction. For this reason 61 patients (55 M, 6 F; mean age 53 years--range 38-73 years) admitted in our CCU for inferior acute myocardial infarction were studied by coronary angiography within 3-5 days from the onset of symptoms. The angiography showed either occlusion or critical coronary stenosis ranging as follows: on right coronary artery proximal (Group 1) to the first branch for right ventricle in 22 patients, on right coronary artery distal to the first branch for right ventricle in 25 patients (Group 2) and on circumflex artery (Group 3) in 14 patients. No difference in LAD disease were noted between the 3 groups. Using myocardial scintigraphy (Tc-99m- pyrophosphate) we confirmed the presence or the absence of right ventricular involvement in the 3 groups. In the 3 groups the magnitude of ST segment depression in V2, selected as representative left-sided precordial lead, ranged as follows: Group 1: -0.25 +/- 1.34 mm; Group 2: -1.64 +/- 1.80 mm; Group 3: -2.00 +/- 1.97 mm. In patients with right ventricular involvement (Group 1) there was a statistically significant reduction of precordial ST segment depression either in comparison to Group 2 (p less than 0.01) or to Group 3 (p less than 0.005) but none between Group 3 and 2. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Diagnosis of acute myocardial infarction by indium-111 antimyosin antibodies and correlation with the traditional techniques for the evaluation of extent and localization.

This clinical study evaluated the accuracy of planar myocardial scintigraphy with antimyosin monoclonal antibodies radiolabeled with indium-111 (AMA-Fab) in the detection and localization of acute myocardial infarction (AMI). Fifty-seven patients admitted for suspected AMI were studied; 17 patients underwent thrombolytic therapy with intravenous streptokinase and 11 had clinical signs of reperfusion; 9 had had a previous myocardial infarction. Fifty of 57 patients were discharged from the coronary care unit with a confirmed diagnosis of AMI. The AMA-Fab study results were positive for AMI in 49 patients (98%) and negative in 1 (2%). Among the 7 patients without AMI, 5 had unstable angina, 1 had Prinzmetal's variant angina and 1 had acute pancreatitis. AMA-Fab results were negative in 6 of 7 patients (85%) and positive in 1 (15%). Therefore, the sensitivity and specificity of AMA-Fab scintigraphy were 0.98 and 0.85, respectively. To assess accuracy in defining the extent and location of AMI, AMA-Fab results were compared with those of the electrocardiogram, echocardiogram, technetium-99m pyrophosphate myocardial scintigraphy and coronary angiography and left ventriculography. AMA-Fab scintigraphy showed a good concordance with the traditional techniques in the topographic definition of the infarcted regions. No uptake of AMA-Fab was seen in the regions of previous old infarcts. Ten healthy volunteers also underwent AMA-Fab scintigraphy. No evidence of myocardial tracer uptake was noted in them. No adverse reactions or side effects were noted after injection of AMA-Fab in any patient. It is concluded that planar myocardial scintigraphy with AMA-Fab is a reliable method for AMI detection and location.

Adult↗
PubMed1989

Electrophysiological evaluation of the sinus node in patients with atrioventricular and/or intraventricular conduction defects.

The authors evaluated retrospectively sinoatrial conduction time (SACT), sinus node recovery time (SNRT), and corrected sinus node recovery time (CSNRT) in 272 patients with atrioventricular and/or intraventricular conduction defects without evidence of overt sinus node dysfunction. The study was designed to determine the prevalence of electrophysiologic sinus node abnormalities in patients with overt atrioventricular and/or intraventricular conduction defects. One or more sinus node electrophysiological abnormalities were observed in 133 cases (48.9%). There was a significant prevalence of electrophysiologic sinus node abnormalities only in patients older than 71 years of age. The data suggest that the involvement of the specialized conduction system is much more diffuse than one might expect simply observing the single recorded ECG defect and that the prevalence of associated defects of the conduction system increases with increasing age of patients.

Adolescent↗
PubMed1989

[Thromboembolus migrating into the right heart in pulmonary embolism. Echocardiographic and clinico-therapeutic aspects in 7 cases and review of the literature].

We report the clinical, echocardiographic and therapeutic aspects and the evolution of 7 cases of right cardiac migrant thromboembolus in pulmonary embolism (5 M and 2 F, aged 43 to 91). Our data are also compared with all the cases reported in the literature (77 patients). During a sample year (1987) we systematically performed two-dimensional echocardiograms (2D Echo) as early as possible in all the patients admitted to our Coronary Care Unit for suspected pulmonary embolism; among 42 patients the diagnosis of pulmonary embolism was confirmed in 30 out of 42 patients. A relatively high incidence of thromboembolus was found (5/30, 17% in 1987); this finding seems to be relative to the early execution of the 2D Echo study (thromboembolus was found in 4/5 patients when 2D Echo was performed within 20 hours and in only 1/23 when 2D Echo was performed later). The 2D Echo was always evocative of freely floating migrant thromboembolus (6 in right atrium, 1 in right ventricle) and no differential diagnosis with thrombi in situ or other masses was necessary. The therapy for 6 patients hospitalized for pulmonary embolism and surviving the first hours (1 patient died immediately) was: surgical in 1 case, medical in the other 5. Medical therapy consisted only of heparin-calcium in one patient and heparin-calcium + dipyridamole in another because of contra-indications for more aggressive therapy. One patient underwent anticoagulant therapy with i.v. heparin. The remaining two underwent fibrinolytic therapy with urokinase and, afterwards, anticoagulant therapy: in 1 case the therapy was started after the embolization of the mass in the pulmonary artery had occurred; in the other one we observed the progressive reduction of thromboembolus until its disappearance within 5 days without any signs of further embolization. All patients survived and were discharged within 25 days, despite the occurrence of lung embolization in 4 of them. The review of 77 cases reported in the literature shows good outcomes for embolectomy when compared with medical therapy, but almost half of the patients underwent surgical therapy directly. Medical therapy experience, particularly with thrombolytic agents (10 cases in all), is still too scarce to exclude its role, as indeed our experience seems to indicate.

Adult↗
PubMed1989

[Hemodynamic effects of the intravenous administration of captopril in patients with chronic congestive heart failure].

The aim of the present study was to evaluate the hemodynamic response to the intravenous administration of the angiotensin converting enzyme-inhibitor captopril. Plasmatic renin activity was also monitored. The study population included 10 patients with chronic congestive heart failure: 3 were in the second NYHA functional class, 5 in the third, and 2 in the fourth. The patients received a first dose of 5 mg of captopril followed, after 10 min, by a second bolus-dose of 15 mg. Hemodynamic and hormonal measurements were repeated in the following 4 hours. The greatest hemodynamic effect, considered as the time of maximal mean arterial pressure and systemic vascular resistances decrease, and cardiac index increase, was noted 20 min after the first bolus dose administration. Mean arterial pressure (MAP) decreased by 13% (p less than 0.01), mean pulmonary artery pressure (MPAP) by 14% (p less than 0.05), right atrial pressure (RAP) by 30% (NS), wedge pressure (WPP) by 23% (p less than 0.01), systemic vascular resistances (SVR) by 21% (p less than 0.05), pulmonary vascular resistances by 22% (NS); cardiac index (CI) increased by 12% (p less than 0.05), stroke volume index by 10% (NS). Heart rate didn't change. The plasmatic renin activity (PRA) increased by 339% (p less than 0.01) reaching the maximal level in concomitance with the greatest hemodynamic effect. Hemodynamic changes were already noted 5 min after the first dose and lasted up to 75 min later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Effects of therapeutic coronary reperfusion on aspartate aminotransferase isoenzymes in sera of patients with acute myocardial infarction.

We examined the kinetics of the catalytic activities of aspartate aminotransferase (AST, EC 2.6.1.1) isoenzymes in serum of 28 patients with myocardial infarction who were to receive either intracoronary urokinase--reperfusion angiographically proved--or conventional therapy (control group). Cytosolic (soluble) AST (s-AST) activity in serum increased rapidly immediately after recanalization, reaching a maximum 12 h after the onset of infarction. In the control group, this peak was reached 28 h after the onset (P less than 0.001). Peak s-AST activity was similar in the two groups. Peak activity and peak time for mitochondrial AST (m-AST) were the same for the two groups of patients; intervention that affects myocardial perfusion caused only a slight additional increase in m-AST activity in the early post-infarct period. There may be advantages to measuring m-AST, which is briefly influenced by reperfusion, instead of the usual cytosolic enzymes for assessment of myocardial damage in patients with myocardial infarction treated with thrombolytic therapy.

Adult↗
PubMed1989

[Prognostic significance of clinical, ergometric and coronarographic data in patients soon after myocardial infarction].

The relative prognostic value of the clinical evaluation (Clin), exercise testing (ET), and cardiac catheterization (Cath), was assessed in 167 consecutive patients who underwent these exams within 40 days after an acute myocardial infarction. Each patient was followed at least 24 months; 12 patients died and 59 presented major cardiac events (angina, reinfarction and death). All the parameters were analyzed by univariate and discriminant and Cox regression analysis. For purposes of analysis, the predictive power of 3 sets of variables was analyzed separately: Clin, Clin + ET, Clin + ET + Cath. In the prediction of major cardiac events, only previous myocardial infarction was selected among the Clin parameters by multivariate analysis while ST segment depression, maximal systolic blood pressure, exercise duration and, though less significantly, coronary artery disease extension were selected among the ET and Cath var. The percentage of patients correctly classified was very low using only the Clin variables (60%) and significantly improved when ET and, to a lesser degree, Cath were added (77% and 80%, respectively). Multivariate discriminant analysis selected, as significant predictors of cardiac death, digitalis therapy, appearance of bundle branch block, previous myocardial infarction and anterior location of the myocardial infarction among the Clin variables, while exercise duration and LV ejection fraction were selected among the ET and Cath variables, respectively. The predictive power of the Clin variables alone was only slightly improved by the use of ET and Cath as the percentage of patients correctly classified was 76%, 81% and 84% using only the Clin, the Clin + ET and the combination of the Clin + ET + Cath var, respectively. In conclusion, the variables associated with a depressed LV function are the best predictors of future death and cardiac events; coronary angiography can only slightly improve the specificity of the exercise testing in the prediction of major cardiac events.

Angiography↗